Journal of JCIC

Balloon atrial septostomy (BAS) was firstly described as an innovative procedure by Dr. Raskind and Dr. Miller in 1966. It has been a conventional procedure for pediatric cardiologists to learn for over 50 years. When performing the classical Raskind method (pullback BAS), both of a fine catheter manipulation and a daring catheter pulling, as a cardiovascular surgeon make a disgusted face, are necessary. In Japan, Raskind catheter, Fogarty catheter, and Miller catheter are available for pullback BAS. We prefer a Fogarty catheter, and choose a 5 Fr sheath (it is hard to introduce) or 6 Fr sheath (residents should use it) according to the body size. As Dr. Mullins described that “The balloon withdrawals should not start with a smaller volume and should not be performed with graduated increasing diameters of the balloon”, an unhesitating pulling of a fully inflated balloon is the key to create an adequate interatrial communication. In patients with low birth weight or a small interatrial communication, atrial septoplasty using 4 to 12 mm angioplasty or valvuloplasty balloon catheters (static BAS). All the operators should make attentions to avoid catheter manipirations in the pulmonary veins or the left ventricle, to confirm a catheter position especially in a case of juxtaposed right atrial appendage, and not to damage the inferior vena cava due to overpulling. As BAS is performed in critically ill patients, effective BAS can immediately lead to the hemodynamic improvement. Echocardiography is also available to make sure a catheter position, and it is used as the solitary imaging modality in several institutions. It is necessary to accumulate experiences because practical manipulations depend on the delicate finger sensation.